Evidence of high rates of undiagnosed asthma in central Ohio elementary schoolchildren.

BACKGROUND: In Ohio, 14.5% of 5- to 9-year-olds and 17.3% of 10- to 17-year-olds have asthma. Moreover, there is concern that these numbers may underestimate the true disease burden. We sought to evaluate variability in asthma rates and respiratory symptoms among central Ohio fourth graders as a means to assess potential undiagnosed and undertreated asthma and its determinants. METHODS: We recruited 13 central Ohio elementary schools representing a broad range of nonurban settings and surveyed fourth graders to estimate school-level physician-diagnosed asthma (PDA), respiratory morbidity, and home exposures to smoking and pets. We used generalized linear mixed models with random intercept for school to examine relationships among exposures, respiratory symptoms, and PDA. RESULTS: Across the 13 schools, 94% of students participated in the survey, and the estimated asthma prevalence rate was 10.2% (N = 101 of 987). An additional 41% reported not having PDA but then went on to report symptoms consistent with asthma potentially suggestive of undiagnosed asthma. Of students with PDA, 21% reported symptoms suggestive of poorly controlled asthma. High levels of secondhand smoke (SHS) exposure were associated both with PDA (p = .05) and with respiratory symptoms (p < .0001). Students who owned a cat or a bird were more likely to report respiratory symptoms (p = .02 and p = .04, respectively). CONCLUSIONS: We provide evidence that the already high childhood asthma public health burden in central Ohio may be underreported. Schools may be an ideal location to conduct screenings and implement environmental interventions oriented toward SHS and household pets that will yield respiratory morbidity benefits.

Evidence of population mixing based on the geographical distribution of childhood leukemia in Ohio.

BACKGROUND: This ecologic study examined the geographic distribution of childhood leukemias in Ohio, 1996-2000, among children aged 0-19 for evidence that population mixing may be a factor. PROCEDURE: (1) State incidence rates were compared to Surveillance, Epidemiology and End Results (SEER) rates for each year and for the 5-year period, 1996-2000; (2) incidence rates for each of Ohio's 88 counties were compared to statewide rates; and (3) county incidence rates were compared based on population density, population growth, and rural/urban locale. SEER*Stat version 5.0 was used to derive age-specific and 0-19 age-adjusted rates. Expected values, standardized incidence ratios (SIRs), and Poisson P-values were calculated with Excel using the indirect method of standardization. RESULTS: Of the 585 cases, 73.3% were acute lymphocytic leukemia (ALL), 16.6% acute myelogenous leukemia (AML), 3.2% acute monocytic leukemia (AMoL), and 2.6% chronic myelogenous leukemia (CML). Rates for total leukemia burden were significantly below national levels for all races (P = 0.00001), likely due to poor ascertainment of cases. Yearly incidence rates for 1996-2000 were stable for ALL and AML; CML rates declined over the period. Based on 2000 Census and intercensal population estimates for 1996-2000, statistically higher rates for ALL were noted for counties experiencing >10% population change 1990-2000 (P < 0.05), especially for ages 1-4 (P < 0.03) in counties with 10-20% growth. Counties 67.9-99.2% urban experienced fewer than expected cases of AML + AMoL (P < 0.06). CONCLUSION: Data support Kinlen's theory of population mixing and warrant further studies in Ohio, the US and other countries.